Boris Khodorkovsky1, Bartholomew Cambria1, Martin Lesser2, Barry Hahn1. 1. Department of Emergency Medicine, Staten Island University Hospital, Staten Island, New York. 2. Biostatistics Unit, Feinstein Institute for Medical Research, Manhasset, New York.
Abstract
BACKGROUND: In the emergency department (ED), hyperkalemia in the presence of hemolysis is common. Elevated hemolyzed potassium levels are often repeated by emergency physicians to confirm pseudohyperkalemia and to exclude a life-threatening true hyperkalemia. OBJECTIVES: We hypothesize that in patients with a normal renal function, elevated hemolyzed potassium, and normal electrocardiogram (ECG), there may not be a need for further treatment or repeat testing and increased length of stay. METHODS: Data were prospectively enrolled patients presenting to the ED from July 2011 to February 2012. All adult subjects who had a hemolyzed potassium level ≥ 5.5 mEq/dL underwent a repeat potassium level and ECG. The incidence of true hyperkalemia in this population was measured. RESULTS: A total of 45 patients were enrolled. The overall median age was 52 years (range 25-83 years); 22 were female (49%). In patients with hyperkalemia on initial blood draw and glomerular filtration rate (GFR) ≥ 60 (n = 45), the negative predictive value was 97.8% (95% confidence interval [CI] 88.2-99.9%). When patients had hyperkalemia on initial blood draw, GFR ≥ 60, and a normal ECG (n = 42), the negative predictive value was 100% (95% CI 93.1-100%). CONCLUSIONS: In the setting of hemolysis, GFR ≥ 60 mL/min in conjunction with a normal ECG is a reliable predictor of pseudohyperkalemia and may eliminate the need for repeat testing. In patients with a normal GFR who are otherwise deemed safe for discharge, our results indicate there is no need for repeat testing.
BACKGROUND: In the emergency department (ED), hyperkalemia in the presence of hemolysis is common. Elevated hemolyzed potassium levels are often repeated by emergency physicians to confirm pseudohyperkalemia and to exclude a life-threatening true hyperkalemia. OBJECTIVES: We hypothesize that in patients with a normal renal function, elevated hemolyzed potassium, and normal electrocardiogram (ECG), there may not be a need for further treatment or repeat testing and increased length of stay. METHODS: Data were prospectively enrolled patients presenting to the ED from July 2011 to February 2012. All adult subjects who had a hemolyzed potassium level ≥ 5.5 mEq/dL underwent a repeat potassium level and ECG. The incidence of true hyperkalemia in this population was measured. RESULTS: A total of 45 patients were enrolled. The overall median age was 52 years (range 25-83 years); 22 were female (49%). In patients with hyperkalemia on initial blood draw and glomerular filtration rate (GFR) ≥ 60 (n = 45), the negative predictive value was 97.8% (95% confidence interval [CI] 88.2-99.9%). When patients had hyperkalemia on initial blood draw, GFR ≥ 60, and a normal ECG (n = 42), the negative predictive value was 100% (95% CI 93.1-100%). CONCLUSIONS: In the setting of hemolysis, GFR ≥ 60 mL/min in conjunction with a normal ECG is a reliable predictor of pseudohyperkalemia and may eliminate the need for repeat testing. In patients with a normal GFR who are otherwise deemed safe for discharge, our results indicate there is no need for repeat testing.
Authors: Matt Wilson; Sam Adelman; J B Maitre; Joe Izzo; Ronald Valencia; Mike Yang; Jeff Dubin; Munish Goyal Journal: West J Emerg Med Date: 2020-10-20